Provider Demographics
NPI:1881082469
Name:GOFORTH, LAUREN NICHOLE (ATC, EMT-B)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:NICHOLE
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:ATC, EMT-B
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:NICHOLE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, EMT-B
Mailing Address - Street 1:1219 THURNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3941
Mailing Address - Country:US
Mailing Address - Phone:937-260-2881
Mailing Address - Fax:
Practice Address - Street 1:810 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:OH
Practice Address - Zip Code:45215-3997
Practice Address - Country:US
Practice Address - Phone:513-526-0981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0040592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer